Provider Demographics
NPI:1275671083
Name:ITO, VALERIE Y (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:Y
Last Name:ITO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 LINDHOLM CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-5313
Mailing Address - Country:US
Mailing Address - Phone:630-961-3343
Mailing Address - Fax:
Practice Address - Street 1:5601 S COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-4875
Practice Address - Country:US
Practice Address - Phone:630-286-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-071403208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071403Medicaid
IL250013178OtherRAILROAD
IL250013179OtherRAILROAD
IL036071403Medicaid
IL250013178OtherRAILROAD
ILL12547Medicare PIN
ILL86157Medicare PIN